Discharge for Palliation

Below is a practical guide of what to do when discharing patient back to their nursing home for palliation - things you may not think about.

1. Have informed discussions with:
   1. The patient if possible
   2. The substitute decision makers – Guardian, family, carer
   3. The GP
   4. The Nursing home staff
2. Ensure there is a registered nurse at the facility who is able to give PRN S8 meds
3. Send the patient home with a 2-3 day supply of meds (especially if over the weekend)
4. Write up a drug chart with all of the new meds and send it back with the patient so that the nursing home staff can administer them prior to the GP transcribing them on the nursing home drug chart
5. Link the patient in with community palliative care or ask the GP if they can do this
   1. Learn what services you have available in your area
   2. Some GPs will be happy to manage these patients in the community alone
   3. Some Nursing homes will have a palliative care CNC who covers their patients
   4. Community palliative care is available in some areas via the local hospice or hospital palliative care teams
6. Crisis Palliative Care Medications

Further References and Resources

• Clinical Excellence Commission's last days of life toolkit
• Alzheimer’s Association - End of life care for people with dementia
• Residential Aged Care Palliative Approach Toolkit

Written with thanks to Dr Nadia Bowman, reviewed by Dr Guru Nagaraj, as part of the ACEM Geriatric Special Skills Term at Hornsby Hospital.